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How does heparinizing ports work?

Posted

Dumb nurse working a floor and I just am not clear on how heparinizing these things works. I never use them, but want to understand them. So when you de-access the port, right before you pull the needle w/ tubing out, you push a syringe of heparin in? I get that it's to keep from clotting, but doesn't it just go into the blood stream?

Edited by Ted D

It also sits in the port. Think of when you prime a cap or tubing with saline.

westieluv

Specializes in Med/Surg, Tele, Dialysis, Hospice. Has 26 years experience.

You are supposed to remove the dwell heparin with an empty syringe before you use the port the next time to avoid over anticoagulating the patient.

classicdame, MSN, EdD

Specializes in Hospital Education Coordinator.

The Infusion Nurses Society standards now state that NS is preferred over heparin to prevent HIT. So yes, you are right, it does affect patient's bloodstream.

It also sits in the port. Think of when you prime a cap or tubing with saline.

So most of the 5ml of heparin sits in the tubing and is removed along w/ the needle when you de-access, but then just a little bit sits in the port?

You are supposed to remove the dwell heparin with an empty syringe before you use the port the next time to avoid over anticoagulating the patient.

So in that case when accessing you would prime the tubing with NS, but then attach an empty syringe and pull back 10ml?

KelRN215, BSN, RN

Specializes in Pedi. Has 10 years experience.

So most of the 5ml of heparin sits in the tubing and is removed along w/ the needle when you de-access, but then just a little bit sits in the port?

The prime volume of the tubing is very small. The size of the port determines how much it holds. I work with ports every day and the standard for my patients is to lock them with 500 units of heparin prior to deaccessing. I have never removed the dwell heparin when accessing- that's a facility specific thing.

The prime volume of the tubing is very small. The size of the port determines how much it holds. I work with ports every day and the standard for my patients is to lock them with 500 units of heparin prior to deaccessing. I have never removed the dwell heparin when accessing- that's a facility specific thing.

So the 500 units would just be injected into their blood stream each time it is accessed?

oncnursemsn

Specializes in Education and oncology. Has 30 years experience.

I work in ambulatory setting- so we access a ton of ports each day. The 5cc heparin flush (100units/1 ml) is used only when the port is de-accessed and needle removed at end of treatment. Remember, heparin has very short 1/2 life, and the 5mls injected goes into the port and the tubing to the tip in the SVC/RA to prevent clot formation at the tip and throughout the catheter. Our patients treated multiple consecutive days are flushed with saline (needle left in) and not heparin flushed until treatment done, needle removed. We find that heparin flushing ports is sufficient to keep most ports patent if done every 4-6 weeks when port not being used. Dwell space of most ports is approx 2.0 to 2.5mls, and catheter to tip end approx 0.8 to 1.2 mls. A 5 cc heparin flush "injects the patient" with less than 200 units heparin, which is negligible in non HIT patient >50 kg. Hope this helps!

KelRN215, BSN, RN

Specializes in Pedi. Has 10 years experience.

I work in ambulatory setting- so we access a ton of ports each day. The 5cc heparin flush (100units/1 ml) is used only when the port is de-accessed and needle removed at end of treatment. Remember, heparin has very short 1/2 life, and the 5mls injected goes into the port and the tubing to the tip in the SVC/RA to prevent clot formation at the tip and throughout the catheter. Our patients treated multiple consecutive days are flushed with saline (needle left in) and not heparin flushed until treatment done, needle removed. We find that heparin flushing ports is sufficient to keep most ports patent if done every 4-6 weeks when port not being used. Dwell space of most ports is approx 2.0 to 2.5mls, and catheter to tip end approx 0.8 to 1.2 mls. A 5 cc heparin flush "injects the patient" with less than 200 units heparin, which is negligible in non HIT patient >50 kg. Hope this helps!

You don't flush with 10u/mL heparin when left accessed?

oncnursemsn

Specializes in Education and oncology. Has 30 years experience.

Good question- when I worked pedi, babes under 10kg received the 10 units/1ml heparin for all central lines. Easy strength to remember based on wt, and of course volume wasn't 5 mls!

KelRN215, BSN, RN

Specializes in Pedi. Has 10 years experience.

Good question- when I worked pedi, babes under 10kg received the 10 units/1ml heparin for all central lines. Easy strength to remember based on wt, and of course volume wasn't 5 mls!

I work pedi and EVERYONE with ports (babies, toddlers, school aged children, teenagers) gets 500 u of heparin before being deaccessed. When they stay accessed, they are typically flushed with 20-30 u q 8-12hr. PICCs are 20-30u q 8 hrs and CVLs 20-30 u q 12hr when at home. I know this varies WIDELY between institutions though because, when I worked in the hospital, we had a fellow who came from Australia who was aghast that we sent families home telling them to flush the line BID because over there, they flush their lines once/week... and supposedly have fewer CLABSIs.

We follow a saline flush with heparin, but in the hep. goes, and in it stays.

iluvivt, BSN, RN

Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience.

INS does still recommends low dose Heparin for Central lines. There has been concern about HIT so many have eliminated or limited the use of Heparin. For example in home care agency where I work we still use it even on PIVS. In the hospital where I work we only use on Hemodialysis Catheters (all types) and on all types of Venous Access Ports.

To answer your question though the port should be flushed prior to deaccess,after each use if locked and every month when not in use. When flushing any CVC you want to flush with 2x the priming volume of the line and most ports have approv 2-2.5 ml. The purpose is to keep the line patent and prevent thrombus formation.This volume varies by brand and can be found on the website of the brand being used. There is no need to discard any of the Heparin prior to reuse if the concentration is 100 units per ml. You will see discard protocols on HD catheters though since the Heparin concentration is greater. Generally you want to use the lowest amount of Heparin as possible for example when a port is locked off and being used frequently we just use 10 units per ml of Heparin but when the therapy is complete and prior to deaccess we will use the 100 units per ml (5MLs). Does that help?

IVRUS, BSN, RN

Specializes in Vascular Access. Has 32 years experience.

The Infusion Nurses Society standards now state that NS is preferred over heparin to prevent HIT. So yes, you are right, it does affect patient's bloodstream.

This is NOT true. Heparin Flush solution is the only accepted locking solution that we have in the USA, or that the FDA has approved in the USA. For central lines, Heparin flush solution is still recommended.

iluvivt, BSN, RN

Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience.

Yes my point too IVRUS! I even know what reference they used for this evidenced based recommendation and at the time I went looking for it I had a difficult time finding it without paying for it but I finally got my hands on it. The effectiveness of an NS flush for PIVS was researched in the 90s and that is when many made the change to NS only on PIVS. Yes its true many still get this confused with CVCs and think it applies to them too! It does not however, mean that you cannot use it if it prescribed or if is the policy in the organization chooses to use for PIVS. I use it in home care on all PIVS that will remain in place.